Terveydenhuollon ammattilaisen ja diabeetikon välisen vuorovaikutuksen merkitys omahoidolle

The purpose of this study is to describe and understand how type 2 diabetic patients’ interpersonal communication experiences with health care professionals are related to diabetes management. Another purpose is to describe and evaluate the applicability of the critical incident technique for studying professional–patient interaction. The aim of this study is to obtain new information about the possibilities and problem areas of professional–patient interaction that can be utilized in an interdisciplinary manner when strengthening diabetes management. In addition, the aim is to bring the voice of diabetic patients out into the social discussion so that the care of diabetic patients can be developed to be more patient centered. The methodological aim is to obtain new information about the applicability of the critical incident technique when studying professional–patient interaction, as well as to show ways to apply the technique in various research settings in the field of health communication.

This study examines type 2 diabetic patients’ interpersonal communication experiences of single-care discussions that occurred with doctors or nurses and that facilitated or impeded diabetes management according to the diabetic patients’ points of views. The study applies the critical incident technique, which is utilized in the planning, implementation, and evaluation of the study (Flanagan, 1954). The diabetic patients’ experiences were collected using an open survey and semistructured interviews. With the help of critical incident technique, 63 significant interpersonal communication experiences have been selected as objects for analyses.

This study consists of four substudies and a summary summarizing their results. The results of the substudies have been gathered together by answering the following research questions that connect the entire study: 1) how professional–patient inter-action facilitates and impedes diabetes management, and 2) how critical incident technique can be applied for studying professional–patient interaction.

The results show that professional–patient interaction that builds a single-care discussion facilitates and impedes diabetes management through three subareas of collaboration: sharing information, showing and receiving social support, and defining collaboration-related roles. If professional–patient interaction succeeds in sup-porting the functioning of the respective subareas of collaboration, the professional– patient interaction will, at its best, also facilitate the planning and implementation of the diabetes management. If the professional–patient interaction does not work as intended, it might impede the functioning of the subareas of collaboration presented above and the appropriate planning and implementation of diabetes management.

The professional–patient interaction is not only about performing tasks and solving the diabetic patient’s problems, but it is also about considering and building a mutual relationship. The health care professional and diabetic patient build their mutual relationship through communicating how they view themselves, one another, and the matter at hand and by managing the competing meanings related to the professional–patient relationship (competing discourses). In terms of communicating views, key characteristics to be considered are building trust in the other party, willingness to communicate, emotional presence, and appropriateness. In terms of giving meanings related to the relationship, the central struggling discourses that the health care professional and diabetic patient must manage in interaction are having the right to care versus deserving care, guidance versus control, and personalization versus standardization. Managing the struggle of discourses is reflected not only in the relationship between the health care professional and diabetic patient built in the single-care discussion, but also in how diabetic patients define the nature of the relationship and its meaning as a part of diabetes management on a more general level.

The methodological results indicate that the critical incident technique is applicable for studying both the health-related outcomes of professional–patient interaction and its multidimensional nature. However, when applying the critical incident technique, epistemological, methodological, and method-related choices and their mutual alignment must be constantly evaluated. In addition, the critical incident technique facilitates diabetic patients in reflecting and structuring professional–patient interaction in a versatile way at the level of single-care discussions – especially when it is possible to reflect by discussing with other people.

The results show that the diabetic patients’ interpersonal communication experiences with health care professionals are related to the planning and implementation of diabetes management through diabetes management–related collaboration. The professional–patient interaction is not only important in terms of the fluency of the care discussion, but it is also important in terms of the implementation of appropriate diabetes management. Thus, every care discussion is an important opportunity to facilitate diabetes management in a more appropriate direction through professional–patient interaction.

The results show that the diabetic patients’ interpersonal communication experiences are related to diabetes management through how patients have experienced the professional–patient interaction in single-care discussions. A central element to facilitating and impeding the significance of the professional–patient interaction is whether the parties succeed in finding a common interaction style, which is built verbally and nonverbally based on the patients’ current communication style, needs, and wishes. However, it is not only about adapting to the diabetic patients’ communication habits and expectations, but it is also about a jointly constructed interaction style, the basis of which is considering the two-way and two-level relation between professional–patient interaction and relationship. Although it must be considered that the relationship always frames the mutual interaction of the parties and that the interaction shapes the relationship, it must also be considered that the relationship between interaction and relationship should be built at least on two levels: in addition to communicating views, it is important for the professional and diabetic patient to pay attention to how they define the nature of the mutual relationship in the inter-action. Moreover, it should be noted that the professional–patient interaction should never take place in a void but is always related to its context. Thus, the professional– patient interaction that builds the single-care discussions must also be related to the prevailing culture and the care practices of diabetic patients.

The results show that diabetic patients’ experiences from single-care discussions also build future care discussions. For this reason, both health care professionals and diabetic patients should reflect the functionality of care discussions and the professional–patient interaction that builds them. The critical incident technique can be used as an aid in reflection, offering both parties good opportunities for analyzing the professional–patient interaction.